NPI | 1508388240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9343369) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9343369) |
363LF0000X Nurse Practitioner, Family (Licence: GA RN276305) | |
Enumeration Date | 2017-07-14 |
Last Update Date | 2019-08-30 |